尿动力学能否预测逼尿肌活动低下的良性前列腺增生症患者前列腺增生手术后的排尿情况？
Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?
作者信息
Thomas Dominique, Zorn Kevin C, Zaidi Nadir, Chen Stephanie Ashley, Zhang Yiye, Te Alexis, Chughtai Bilal
机构信息
Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA.
Section of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada.
出版信息
Asian J Urol. 2019 Jul;6(3):264-269. doi: 10.1016/j.ajur.2018.12.005. Epub 2018 Dec 18.
OBJECTIVE
We sought to determine if urodynamic study (UDS) predicted voiding outcomes in men with detrusor underactivity (DU) and benign prostatic enlargement (BPE) who underwent photovaporization of the prostate (PVP).
METHODS
Between September 2010 and July 2015, 106 male patients with BPE and DU were identified. All patients underwent PVP. Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter. Data collection included comorbidities, quality of life (QoL) scores, prostate volume, prostate-specific antigen (PSA), UDS and perioperative outcomes. UDS parameters included volume at first desire to void, volume at first urge to void, volume of severe urge, volume at capacity, compliance, detrusor contractions, maximum urinary flow rate (Q), and postvoid residual (PVR).
RESULTS
A total of 106 men were included in this analysis, who had urinary retention with a Foley catheter or clean intermittent catheterization (CIC) at the time of surgery. At baseline we found patients who voided had a detrusor pressure at Q (P@Q) of 10.05 ± 6.45 cmHO compared to 16.78 ± 12.17 cmHO in those who did not void ( = 0.071). Postoperatively, 96 (90.6%, mean age 76.9 ± 26.2 years) of patients voided successfully while 10 (9.4%, mean age 80.52 ± 9.61 years) of patients remained in urinary retention. Mean baseline Q was 4.895 ± 5.452 mL/s and 2.900 ± 3.356 mL/s ( = 0.087) in those who voided and did not respectively. PVR was 319.23 ± 330.62 mL in those who voided and 276.88 ± 263.27 mL ( = 0.344) in those who did not void. No UDS parameter predicted who would void postoperatively or improvements in QoL.
CONCLUSIONS
The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings. All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.
目的
我们试图确定尿动力学研究（UDS）能否预测接受前列腺光汽化术（PVP）的逼尿肌活动低下（DU）和良性前列腺增生（BPE）男性患者的排尿结果。
方法
2010年9月至2015年7月期间，确定了106例患有BPE和DU的男性患者。所有患者均接受了PVP。根据术前是否需要留置或间歇性导尿来记录尿潴留情况。数据收集包括合并症、生活质量（QoL）评分、前列腺体积、前列腺特异性抗原（PSA）、UDS和围手术期结果。UDS参数包括首次有排尿欲望时的尿量、首次有尿急感时的尿量、强烈尿急时的尿量、膀胱容量、顺应性、逼尿肌收缩、最大尿流率（Q）和残余尿量（PVR）。
结果
本分析共纳入106名男性，他们在手术时存在留置导尿管或清洁间歇性导尿（CIC）的尿潴留情况。在基线时，我们发现能够排尿的患者在最大尿流率时的逼尿肌压力（P@Q）为10.05±6.45 cmH₂O，而不能排尿的患者为16.78±12.17 cmH₂O（P = 0.071）。术后，96例（90.6%，平均年龄76.9±26.2岁）患者成功排尿，而10例（9.4%，平均年龄80.52±9.61岁）患者仍存在尿潴留。能够排尿的患者和不能排尿的患者的平均基线Q分别为4.895±5.452 mL/s和2.900±3.356 mL/s（P = 0.087）。排尿患者的PVR为319.23±330.62 mL，未排尿患者的PVR为276.88±263.27 mL（P = 0.344）。没有UDS参数能够预测术后哪些患者能够排尿或生活质量的改善情况。
结论
DU和BPE患者在接受PVP后可能能够成功排尿，无论UDS结果如何。与基线相比，所有能够排尿的男性患者的国际前列腺症状评分和生活质量评分均有所改善，且这些参数在长达12个月内保持稳定。
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